Current Trends and Guidelines for Breast Cancer Screening in Transgender Patients

Purpose: To review the current screening guidelines for transfeminine and transmasculine patients as well as barriers to breast cancer screening.

Methods/Materials: It is increasingly important for radiologists to be aware of the current guidelines and evidence-based transgender care, especially for breast cancer screening. For example, most transgender women (assigned male sex at birth with feminine gender identity) who receive feminizing hormones (usually estrogen and antiandrogens) will develop either heterogeneously dense or extremely dense breast tissue, increasing the risk of breast cancer. A review of the most up to date guidelines and trends in transgender breast cancer screening was performed.

Results: A wide array of benign and malignant pathology may be encountered in transgender women like those found in cisgender women (assigned female sex at birth and identify as women), including cysts and fibroadenomas. Transgender women who receive feminizing hormones may be at increased risk of breast cancer. There have been variable screening guidelines published among several expert consensus groups. Most recently in 2021, the American College of Radiology recommended annual screening mammography beginning at age 40 for transfeminine patients who have used hormones for ≥5 years, as well as for transmasculine patients who have not had chest masculinization surgery. In 2022, Oladeru et al. found that common barriers to screening adherence include expensive medical costs, access to primary care providers, and denial of coverage from insurance companies. Along similar lines, medical training has not traditionally included a curriculum on transgender health for which medical providers may be unaware of the unique health disparities and screening recommendations that exist in this patient population. Data shows that patients are more likely to be screened if recommended by a healthcare professional.

Conclusions: Current evidence and guidelines support an organized approach to transgender breast cancer screening. Barriers to screening recommendations increase transgender healthcare disparities and ultimately contribute to poor health outcomes.